Oderda Marco, Ricceri Fulvio, Pisano Francesca, Fiorito Chiara, Gurioli Alberto, Casetta Giovanni, Zitella Andrea, Pacchioni Donatella, Gontero Paolo
Department of Urology 1, AOU San Giovanni Battista, University of Turin, Turin, Italy.
Urol Int. 2013;90(2):184-90. doi: 10.1159/000343431. Epub 2013 Jan 17.
To prospectively evaluate the prognostic utility of the traditional prognostic factors and molecular markers p53 and Ki-67 in a homogeneous series of patients with non-muscle-invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG).
192 intermediate- and high-risk NMIBC cases were enrolled. The variables in study were age, stage, grade, focality, tumour size, presence of associated carcinoma in situ, recurrence rate before BCG, maintenance for BCG, Ki-67 and p53. The endpoints considered were recurrence-free survival, progression-free survival, cancer-specific survival (CSS) and overall survival (OS).
T stage resulted in being associated with CSS, whereas age with OS. BCG maintenance was a significantly favourable independent predictor of OS, CSS, recurrence and progression. In univariate analysis, the labelling index of Ki-67 was significantly associated with OS, CSS and progression. Multivariate analysis, however, confirmed this association only for OS. On the contrary, the labelling index of p53 was a significant predictor of recurrence, both in uni- and multivariate analyses, but with a HR inferior to 1.
Ki-67 was an independent predictor of survival. p53 overexpression showed a significant yet inverse correlation with recurrence, thus showing little clinical utility. Age, stage and maintenance were confirmed as independent predictors of BCG response.
前瞻性评估传统预后因素以及分子标志物p53和Ki-67在接受卡介苗（BCG）治疗的非肌层浸润性膀胱癌（NMIBC）同质患者系列中的预后效用。
纳入192例中高危NMIBC病例。研究中的变量包括年龄、分期、分级、病灶范围、肿瘤大小、伴发原位癌情况、BCG治疗前复发率、BCG维持治疗情况、Ki-67和p53。所考虑的终点为无复发生存期、无进展生存期、癌症特异性生存期（CSS）和总生存期（OS）。
T分期与CSS相关，而年龄与OS相关。BCG维持治疗是OS、CSS、复发和进展的显著有利独立预测因素。在单因素分析中，Ki-67的标记指数与OS、CSS和进展显著相关。然而，多因素分析仅证实其与OS存在这种关联。相反，p53的标记指数在单因素和多因素分析中均是复发的显著预测因素，但风险比小于1。
Ki-67是生存的独立预测因素。p53过表达与复发呈显著负相关，因此临床效用不大。年龄、分期和维持治疗被确认为BCG反应的独立预测因素。
